Objective To investigate the current status of knowledge, attitude, and practice (KAP) regarding pulse indicator continuous cardiac output (PiCCO) monitoring care among ICU nurses, to analyze the influencing factors, and to provide a basis for developing targeted training programs. Methods A convenience sample of 641 ICU nurses from 12 tertiary Grade A hospitals across eight provinces in China was recruited between August and September 2025. Data were collected using a general information questionnaire and a self-developed questionnaire assessing ICU nurses′ knowledge, attitudes, and practices regarding PiCCO monitoring nursing. Results The total KAP score for PiCCO monitoring nursing among ICU nurses was 145.17±28.47. The median scores for the knowledge, attitude, and practice dimensions were 67.00(58.00, 78.00), 36.00(36.00, 44.50), and 43.00(34.00, 49.00), respectively. Multiple stepwise linear regression analysis revealed that professional title, administrative position, nursing level, specialty nurse status, and learning experience related to PiCCO monitoring were significant factors influencing KAP levels regarding PiCCO monitoring nursing (all P<0.05). Conclusion ICU nurses demonstrated positive attitudes toward PiCCO monitoring nursing; however, their knowledge level was suboptimal and practical implementation requires further improvement. Nursing administrators should provide systematic and targeted training based on nurses′ individual characteristics to enhance their knowledge, attitudes, and practices regarding PiCCO monitoring nursing, thereby ensuring the accuracy and reliability of hemodynamic monitoring.